Bone disease and fractures are common in men and women with chronic kidney disease (CKD). The etiology of fractures in CKD is multi-factorial; identifying risk factors for fracture is important in CKD, so that patients who are at high risk can be treated before they fracture. The majority of studies have focused on risk factors associated with fracture in patients with stage 5 CKD on dialysis–there is a need for studies in pre-dialysis CKD. Three novel, non-radiological factors were assessed in 211 men and women with stage 3-5 CKD: cytokines osteoprotegerin (OPG) and receptor activator of nuclear factor kappa beta ligand (RANKL); tests of neuromuscular function including the timed up and go (TUG), 6 minute walk (6MW), and grip strength; and daily activity levels by accelerometry. Fractures were defined as self-reported low-trauma fractures since the age of 40 and/or prevalent vertebral fractures identified by morphometry. Logistic regression and receiver operating characteristic curves (ROC) were performed using STATA version 11.0. Those with fractures had elevated OPG compared to those without fractures (9.37±4.23 vs. 8.13±3.04 pmol/L, p=0.03), however, after adjusting for age OPG did not differ by fracture status. After adjusting for age, weight, and sex, impairments in both the TUG and 6MW tests were associated with fractures (TUG odds ratio (OR): 1.68, 95% confidence interval (CI): 1.40-2.02; 6MW OR: 0.53, 95% CI: 0.52-0.54). The diagnostic tests characteristics of the TUG and 6MW tests were excellent; both could discriminate fracture status (TUG AUROC: 0.90, 95% CI: 0.84-0.95; 6MW AUROC: 0.87, 95% CI: 0.84-0.95). Overall, subjects were primarily sedentary. After adjusting for stage of CKD, increased sedentary activity and decreased light intensity activity could discriminate fracture status (sedentary AUROC: 0.72, 95% CI: 0.56 to 0.87; light activity AUROC: 0.71, 95% CI: 0.55 to 0.87). In conclusion, non-radiological, novel factors including the TUG, the 6MW, and daily activity, but not OPG or RANKL were able to discriminate fracture status in men and women with stage 3-5 CKD.

Bone disease and fractures are common in men and women with chronic kidney disease (CKD). The etiology of fractures in CKD is multi-factorial; identifying risk factors for fracture is important in CKD, so that patients who are at high risk can be treated before they fracture. The majority of studies have focused on risk factors associated with fracture in patients with stage 5 CKD on dialysis–there is a need for studies in pre-dialysis CKD. Three novel, non-radiological factors were assessed in 211 men and women with stage 3-5 CKD: cytokines osteoprotegerin (OPG) and receptor activator of nuclear factor kappa beta ligand (RANKL); tests of neuromuscular function including the timed up and go (TUG), 6 minute walk (6MW), and grip strength; and daily activity levels by accelerometry. Fractures were defined as self-reported low-trauma fractures since the age of 40 and/or prevalent vertebral fractures identified by morphometry. Logistic regression and receiver operating characteristic curves (ROC) were performed using STATA version 11.0. Those with fractures had elevated OPG compared to those without fractures (9.37±4.23 vs. 8.13±3.04 pmol/L, p=0.03), however, after adjusting for age OPG did not differ by fracture status. After adjusting for age, weight, and sex, impairments in both the TUG and 6MW tests were associated with fractures (TUG odds ratio (OR): 1.68, 95% confidence interval (CI): 1.40-2.02; 6MW OR: 0.53, 95% CI: 0.52-0.54). The diagnostic tests characteristics of the TUG and 6MW tests were excellent; both could discriminate fracture status (TUG AUROC: 0.90, 95% CI: 0.84-0.95; 6MW AUROC: 0.87, 95% CI: 0.84-0.95). Overall, subjects were primarily sedentary. After adjusting for stage of CKD, increased sedentary activity and decreased light intensity activity could discriminate fracture status (sedentary AUROC: 0.72, 95% CI: 0.56 to 0.87; light activity AUROC: 0.71, 95% CI: 0.55 to 0.87). In conclusion, non-radiological, novel factors including the TUG, the 6MW, and daily activity, but not OPG or RANKL were able to discriminate fracture status in men and women with stage 3-5 CKD.

Denna studie har gjorts för att se hur personal på daglig verksamhet uppfattar sitt eget bemötande och hur de arbetar med att ge ett bra bemötande. Den forsknings som finns är begränsad, speciellt inom det valda området och det finns en gemensam medvetenhet hos forskarna att det finns en bemötandeproblematik. En medvetenhet hos forskarna att det behövs mer utbildning som handlar om kommunikation och bemötande. Metoden som har använts i denna studie är en kvalitativ metod med semi-strukturerade intervjuer. Den personal som deltog i studien arbetade inom kommunalt eller på privatägd daglig verksamhet runt om i sydvästra Skåne. Personalen fick möjligheten att reflektera över sitt bemötande och det fanns en medvetenhet i när ett dåligt bemötande gavs och detta såg personalen som en del av en process. De såg sitt bemötande av brukarna som viktigt och betydelsefullt och för att stärka brukarnas empowerment bemöter personalen dem med respekt genom att skapa tillit och trygghet hos brukarna. Det som studien kom fram till var att personalen hade en medvetenhet inom sitt eget bemötande och att utbildning var en viktig del av att skapa sig kunskap och erfarenheter inom bemötande och kommunikation. Personalen hade även en förförståelse i hur kommunikation och attityder hörde ihop med bemötandet och hur de kunde förbättra sitt bemötande genom att reflektera och diskutera med sina medarbetare. / This study has been done to see how the staff in daily activity centers experience their interaction and how they are working to provide a good response. There is a limited amount of studies in the chosen field and there is a common awareness among scientists that an attitude problem exists. There is an awareness of the fact that it needs more education about communication and interaction. The study was carried out with a qualitative method with semi-structured interviews. The staff who participated in the study worked in privately owned or publicly managed daily activity centers across the southwest of Skåne. By having the staff reflect on their approach and how they interacted, it raised an awareness of when a less than ideal interaction had occurred and this was seen as a part of the process. They saw their interaction with the users as important and significant. To facilitate empowerment to the user, the staff treats the users with respect. This helps build up a sense of trust and security between them.The conclusion of the study was that staff members were aware of their own interaction with their users and that education was an important part of creating knowledge and experience in interaction and communication. The staff also had an understanding of how communication and attitudes belonged to the interaction and how they could improve their approach by reflecting and discussing it with their fellow staff members.

Injuries associated with fall accidents pose a significant health problem to society, both in terms of human suffering and economic losses. Existing fall intervention approaches are facing various limitations. This dissertation presented an effort to advance indirect type of injury prevention approach. The overall objective was to develop a new fall event detection algorithm and a new integrative ambulatory measurement (IAM) framework which could further improve the fall detection algorithm's performance in detecting slip-induced backward falls. This type of fall was chosen because slipping contributes to a major portion of fall-related injuries. The new fall detection algorithm was designed to utilize trunk angular kinematics information as measured by Inertial Measurement Units (IMU). Two empirical studies were conducted to demonstrate the utility of the new detection algorithm and the IAM framework in fall event detection. The first study involved a biomechanical analysis of trunk motion features during common Activities of Daily Living (ADLs) and slip-induced falls using an optical motion analysis system. The second study involved collecting laboratory data of common ADLs and slip-induced falls using ambulatory sensors, and evaluating the performance of the new algorithm in fall event detection. Results from the current study indicated that the backward falls were characterized by the unique, simultaneous occurrence of an extremely high trunk extension angular velocity and a slight trunk extension angle. The quadratic form of the two-dimensional discrimination function showed a close-to-ideal overall detection performance (AUC of ROCa = 0.9952). The sensitivity, specificity, and the average response time associated with the specific configuration of the new algorithm were found to be 100%, 95.65%, and 255ms, respectively. The individual calibration significantly improved the response time by 2.4% (6ms). Therefore, it was concluded that slip-induced backward fall was clearly distinguishable from ADLs in the trunk angular phase plot. The new algorithm utilizing a gyroscope and orientation sensor was able to detect backward falls prior to the impact, with a high level of sensitivity and specificity. In addition, individual calibration provided by the IAM framework was able to further enhance the fall detection performance. / Ph. D.

Šio tyrimo tikslas yra ištirti žmonių, turinčių sunkių, ilgalaikių psichikos sutrikimų, kasdieninę veiklą. Tyrimo uždaviniai: 1. Ištirti, kaip skiriasi sveikųjų ir sergančiųjų ilgalaikėmis ir sunkiomis ligomis veikla per parą. 2. Nustatyti sveikiems ir sergantiems ilgalaikėmis ir sunkiomis ligomis svarbiausias veiklas. 3. Nustatyti sergantiesiems iškylančias problemas kasdieninėje veikloje. 4. Ištirti sergantiems ilgalaikėmis ir sunkiomis ligomis patinkančias ir nepatinkančias veiklas. Tyrimui buvo naudojamas kasdieninės veiklos vertinimo klausimynas, sukurtas pagal žmogaus užimtumo modelį (Kielhofner 1988). Klausimynas susideda iš kasdieninio tvarkaraščio blokų kas valandą, kuriuos reikia pildyti, norint parodyti kasdieninį užimtumą. Pacientas vertina tokias veiklas kaip: darbas, kasdieninė ruoša, laisvalaikis, poilsis. Pacientas taip pat prašomas įvertinti kiekvieną veiklą balais, atsakant į klausimus: kaip gerai jo manymu atlieka veiklą, kiek svarbi ir kaip patinka jam vertinama veikla. Tiriamieji apklausti anoniminiu anketavimo būdu, paaiškinus jiems apklausos tikslą ir gavus sutikimą naudoti gautą informaciją. Tiriamųjų kontingentą sudarė 121 žmogus: 61 turintys ilgalaikius, sunkius psichikos sutrikimus (šizofrenija ir depresija) ir 60 žmonių neturinčių psichikos sutrikimų, kurie sudarė kontrolinę grupę. Tyrimo metu išaiškėjo, kad sveikų ir sergančių psichinėmis ligomis veikla skiriasi. Psichiniai ligoniai gyvena nesubalansuotai. Labiausiai išryškėja skirtumai miego... [toliau žr. visą tekstą] / The aim of this research is to investigate daily activity of people with long-lasting psychical disorders. The following are the objectives of the research: 1. To examine how different the activity of the healthy and those suffering from long-lasting and serious diseases is during the day. 2. To determine the most important activities for the healthy and those suffering from long-lasting and serious diseases. 3. To determine the problems which arise for the sick in their daily activity. 4. To analyze the activities admired and disliked by the sick. For the research the questionnaire of assessment of daily activity has been employed which has been created according to the man’s occupation model. (Kielhofner 1988). The questionnaire is comprised of blocks of daily hourly timetable, which should be filled in so that daily employment was shown. The patient assesses such activities as work, everyday preparation, leisure time, rest. The patient is also asked to assess each activity by scores answering the questions: how well the activity is performed in his opinion, how important it is and how he likes the activity assessed. The respondents have been interviewed by anonymous questionnaire survey method explaining them the aim of the survey and getting their agreement to use the information obtained. The contingent of the patients under examination has been comprised of 121 people: 61 persons who have long-lasting, serious psychical disorders (schizophrenia and depression) and 60... [to full text]

Individuals who use wheelchairs or who have other mobility challenges often are unable to access modern mobility systems "“ including application-based ride hailing and on-demand microtransit. Even designing a system targeted at these users is challenging, given the limited prior analysis of their travel behavior and activity patterns. Simulation tools are used by cities around the world to understand novel and complex transportation systems, yet few are including the needs of users with disabilities in these simulation studies. This thesis examines the travel patterns of wheelchair users from the 2017 National Household Travel Survey and presents a model of daily activity pattern choice of respondents who self-identify as using a wheelchair. This thesis discusses the application of a wheelchair status variable in the activity-based travel demand model ActivitySim and measures its effect on individual and household daily activity pattern choice. Wheelchair use is estimated to reduce the utility of a work daily activity pattern by 1.9 points relative to a home pattern for full time workers and 3.4 for part time workers. Including the effect of wheelchair use in a regional daily activity pattern model resulted in 21.9 percent of wheelchair users changing to a home activity pattern relative to a base scenario not including wheelchair use. Lastly, the thesis evaluates the performance of an on-demand, accessible mode for users with wheelchairs in the agent-based microsimulation BEAM. This simulation showed that demand for such a service increases linearly with fleet size and wait time remains constant, though further scenario refinement and research is necessary.

京都大学 / 0048 / 新制・課程博士 / 博士(理学) / 甲第19221号 / 理博第4113号 / 新制||理||1592(附属図書館) / 32220 / 京都大学大学院理学研究科生物科学専攻 / (主査)教授 伊谷 原一, 教授 幸島 司郎, 教授 村山 美穂 / 学位規則第4条第1項該当 / Doctor of Science / Kyoto University / DGAM

Studies and reports have shown that a significant portion of young individuals with intellectual disabilities who complete their studies at special needs upper-secondary school find themselves outside the labor market. Among these, a considerable number are described as being somewhere else, i.e., not in employment, education, or daily activities. This is despite Sweden, through the ratification of the UN Convention on the Rights of Persons with Disabilities (Ds 2008:23), acknowledging their right to work on equal terms as others. The aim of this essay is to highlight the underlying reasons why young individuals with intellectual disabilities are excluded from the labor market and the reasons they find themselves in NEED (Not in Employment, Education, or Daily Activity). In a non-systematic literature review, twelve scientific articles found through PsycInfo and Libsearch were examined to address the challenges and opportunities that young individuals with intellectual disabilities face in relation to employment and work. The results were then analyzed based on theories of stigma, social justice, and developmental ecology. The findings primarily point to three reasons why young individuals with intellectual disabilities are excluded from labor markets and are in NEED: 1. stigmatization of the group, 2. structural barriers such as a complex welfare system and limited educational opportunities, and 3. difficulties in participating in today's work structure due to limited adaptive abilities.

This essay aims to examine the meaning work at daily activity centers gives people with intellectual disabilities and the questions these people consider necessary to ask in quality surveys. This has been done by interviews with twelve respondents in various daily activitiy centers within a private care company in the Stockholm area. The theories that has been used to analyze the empirical data is SOC - sence of coherence, stigma and empowerment. The result shows that the meaning of daily activity is to create and maintain social contacts, feeling important and needed by others and an opportunity to feel “normal” and like everybody else. Furthermore, the results show that the possibility of self-determination, the fellowship with personal and other participants and to have tasks with moderate severity are necessary questions to ask in quality surveys. Another result shows that the respondents are aware that the absence of salary differs a regular job from work in a daily activity center.

Orientador: Maria Beatriz Rocha Ferreira / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação Fisica / Made available in DSpace on 2018-08-10T17:27:47Z (GMT). No. of bitstreams: 1 Souza_AluisioFernandesde_M.pdf: 4888385 bytes, checksum: fec4eed43604c966463ce5662f6be09f (MD5) Previous issue date: 2008 / Resumo: Pertencentes ao grupo étnico Guaná e à família lingüística Aruák, os Terena foram um dos subgrupos que migraram no século 19 para as terras que atualmente correspondem ao Estado do Mato Grosso do Sul. Tiveram bom relacionamento com a sociedade urbana local até a Guerra do Paraguai, que desencadeou conflitos por terras, criando uma situação de espoliação territorial que não apenas extraiu da etnia o espaço necessário para reproduzir seus hábitos, como também os colocou mais próximos de áreas urbanas. Em recente diagnóstico da Fundação Nacional de Saúde - FUNASA (2003) observouse aumento dos casos de Diabetes Mellitus e pressão alta entre os indígenas da região, mais intensamente entre os Terena. Em 2004, outro estudo denominado Avaliação Antropométrica entre os Terena da Aldeia Limão Verde no Município de Aquidauana (n=161), diagnosticou sobrepeso e obesidade em 60% dos pesquisados. Sabe-se que indivíduos inativos fisicamente têm maior propensão ao desenvolvimento de agravos à saúde, advindo daí o interesse, problematizado pela questão: Qual o nível de Atividade Física (AF) presente entre os Terena do Estado do Mato Grosso do Sul? Assim, foi desenvolvido o levantamento do percurso histórico da AF na etnia Terena, por meio de uma metodologia voltada à cosmologia, que empreendeu o conhecimento de aspectos como história étnica, mitos e territorialidade, contextualizados à análise da AF, principalmente a cotidiana e de subsistência, assim como a compreensão de atividades como Jogo e Esporte na etnia. Foram campos de pesquisa as aldeias Buriti e Córrego do Meio, do Pólo-Base de Sidrolândia - MS. Os instrumentos utilizados foram questionários quali-quantitativos aplicados aos Líderes Esportivos (n=04) e Jovens Adultos Terena de ambos os sexos (n=79) e aplicaçãO' do lnternational Physical Activity Questionnaire IP AQ, na versão 6 - visando estimar o nível de AF entre Jovens Adultos Terena. Entrevistas Informais foram utilizadas para complementar as informações dos questionários formais'.. Os dados coletados receberam tratamento estatístico pelos so.ftwares SPSS@ Versão 11 e Microsoft Excel@ versão 2007. Foram obtidas as seguintes conclusões: há maior flexibilização na organização social Terena; as aldeias têm in:&a-estrutura de saúde e serviços básicos, com moradias similares às existentes em zonas rurais; houve redução nas atividades de extrativismo, junto à resignificação de algumas de suas modalidades; a criação de pequenos animais junto da agricultura são as principais atividades de subsistência da etnia, com predominffhcia da avicultura; os hábitos e preferência alimentar se mostraram similares aos do homem urbano; as mulheres evidenciaram ser o grupo de maior incidência de sobrepeso e obesidade; os jogos tradicionais conhecidos e praticados na etnia são jogos como argolinha, arco e flecha e dança; os esportes são amplamente praticados no cotidiano da etnia, particularmente o futebol e o voleibol e por fim, os níveis de AF mensurados por meio do IPAQ indicaram o grupo pesquisado como Ativos e Muito Ativos fisicamente - resultado ocasionado provavelmente pela prática :&eqüente de caminhada e pedalada dentro da rotina cotidiana, resultado que remete à necessidade de desenvolvimento pé outros estudos relacionados à validação do IPAQ entre os Povos Indígenas, procurando confirmar os achados deste estudo / Abstract: Belonging to the ethnic group Guana and to the linguistic family Aruák, the Terena were one of the subgroups who migrated to the, now known, state of Mato Grosso do Sul during the XIX Century. They had a good relationship with the local urban society until the war between Brazil and Paraguay, which caused a lot of dispute for land, creating a situation of property spoliation that had not only taken them from the place where they could keep their habits, but had also pushed them near to the urban areas. In a recent study from the Brazilian National Health Foundation - FUNASA (2003) an increase of Diabetes Mellitus and High Blood Pressure was seen among Indians from that region, with more intensity among the Terena. In 2004, another study known as Anthropometric Evaluation of the Terena Village Limao Verde in the municipality of Aquidauana (n= 161), found 60% of the subjects as overweight or obese. It' s known that those who do not perform any physical activity have greater chance to develop health problems. So in this matter was the interest based, and presented with the following question: What is the level of Physical Activity (PA) among the Terena from Mato Grosso do Sul? Thus, was developed a research about the historical habits of PA among them through a cosmologic method, which explored the knowledge ofthe ethnic's history, myths and territorialism, contextualized to analyze the PA, mainly of daily and subsistence activities, as well as the understanding of games and sports among them. The villages studied were the ones from Buriti and Corrego do Meio, from the Sidrolandia county in the Mato Grosso do Sul state. The instruments used were quali-quantitative questionnaires applied to the sport's leaders (n=04) and Terena young adults of both sexes (n=79), and the applicatíon of the Intemational Physical Activity Questionnaire - IPAQ, version 6 - aiming for the level of PA among Terena young adults. Informal interviews were done to complement the results from the fonnal methods. The data was formatted in a statistical way through the software SPSS@ version 11 and MS-Excel@ version 2007. the following conclusions were obtained: there is a greater flexibility in the Terella's social organization; the villages have health system and basic services, with dwellings to those from rural areas; there has been a decrease in extracting activities, together with the adapting of some modalities; raising small animals along the fields are their main subsistence activities, with predominance to poultry; the eating habits and preferences were shown similar to the urban society; women were found to be the group with more cases of overweight and obesity; the traditional games known and practiced are games like throwing hoops, arrow shooting and dance; sports are widely practiced among them in a regular basis, particularly soccer and volleyball. Finally the level of PA measured by the IP AQ found the studied groups to be physically active or very active - finding, probably resulting from daily biking and walking, which gives us the necessity of performing other studies related to the IP AQ validation among Indians, trying to confirm the findings of this study / Mestrado / Atividade Fisica, Adaptação e Saude / Doutor em Educação Física